<div id=tiga_ba>
	<div id=tiga_baa>Tambah Pengguna</div>
	<div id=tiga_bab></div>
	<div class=clear></div>
</div>
            
<form action="utama.php?module=mod_user&act=simpan" onsubmit="return gsValidate('username|nama_lengkap|password','Username Harus Diisi|Nama Harus Diisi|Password Harus Diisi','required|required|required');" method="post" enctype="multipart/form-data">
	<table style="margin: 10px 15px 10px 15px;">
		<tr>
			<td scope="col">Username</td>
			<td scope="col">
				<input name="username" type="text" class="input2" id="username" maxlength="30" />
				<span class="red">*</span>
			</td>
		</tr>
		<tr>
			<td>Password</td>
			<td>
				<input name="password" type="password" class="input2" id="password" maxlength="200" />
				<span class="red">*</span>
			</td>
		</tr>
		<tr>
			<td>Nama Lengkap</td>
			<td>
				<input name="nama_lengkap" type="text" class="input2" id="nama_lengkap" maxlength="200" />
				<span class="red">*</span>
			</td>
		</tr>
		<tr>
			<td>Kantor</td>
			<td>
				<select name="kantor" class="input2" id="kantor">
					<option value="0"> Jamkesda </option>
					<?php
						$kantor = mysql_query("select id_ppk,nama from ppk");
						while($k = mysql_fetch_array($kantor)){
							echo "<option value=$k[id_ppk]>$k[nama]</option>";
						}
					?>
				</select>
			</td>
		</tr>
		<tr>
			<td>Level</td>
			<td>
				<select name="level" class="input2" id="level">
					<?php
						$level = mysql_query("select * from jenis_pengguna");
						while($l = mysql_fetch_array($level)){
							echo "<option value=$l[id_jenis_pengguna]>$l[nama]</option>";
						}
					?>
				</select>
			</td>
		</tr>
		<tr>
			<td>Status</td>
			<td>
				<select name="status" class="input2" id="status">
					<option value="Y">Aktif</option>
					<option value="N">Tidak Aktif</option>
				</select>
			</td>
		</tr>
		<tr>
			<td>&nbsp;</td>
			<td><input name="submit" type="submit" class="button" value="Simpan" /></td>
		</tr>
	</table>                
</form>		
            
        